Uterine carcinosarcoma (malignant mixed Müllerian tumor): case report in a goat and literature review

Carcinosarcomas are biphasic malignant tumors composed of 2 distinct neoplastic cell populations, epithelial cells and mesenchymal cells. A 13-y-old, female, mixed-breed goat was presented with a 1-wk history of anuria and lethargy. Transabdominal ultrasonography showed an irregular and heterogeneous structure in the region of the bladder and uterus and changes in the echogenicity of both kidneys. Given the poor prognosis, euthanasia was elected. Autopsy revealed a large mass within the uterine cervix and confirmed the changes in the urinary tract. Histopathology and immunohistochemistry revealed a mixed, anti-cytokeratin AE1/AE3–positive epithelial, and vimentin-positive mesenchymal neoplasm consistent with a homologous carcinosarcoma, also called malignant mixed Müllerian tumor, with areas of double-labeling. We highlight the complexity of the diagnosis of uterine neoplasms in domestic animals and in goats in particular.

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Malignus kevert Müller-cső-eredetű tumor komplex kezelése

Orvosi Hetilap ◽

10.1556/650.2018.31039 ◽

2018 ◽

Vol 159 (19) ◽

pp. 741-747

Author(s):

Judit Kalincsák ◽

Péter Gőcze ◽

József Bódis ◽

Krisztina Kovács ◽

Ágnes Stefanovits ◽

...

Keyword(s):

Overall Survival ◽

Postoperative Treatment ◽

Uterine Neoplasms ◽

Bilateral Oophorectomy ◽

Malignant Mixed Mullerian Tumor ◽

Number Of Patients ◽

Malignant Mixed Müllerian Tumor ◽

Mixed Müllerian Tumor ◽

Mixed Mullerian Tumor ◽

Mullerian Tumor

Abstract: Introduction and aim: The aim of our study was to evaluate the prognostic factors and treatment options of a very rare and highly aggressive type of uterine neoplasms, the malignant mixed Müllerian tumor, known as carcinosarcoma. Method: Between 2009 and 2017, 29 patients were treated with malignant mixed Müllerian tumor. At stage I, surgery and postoperative radiotherapy were performed. At stages II−IV, trimodal treatment (surgery, chemotherapy and radiotherapy) was administered. Results: The average age of patients was 68.51 (49–90) years, mean body mass index was 30.22 (20.90–37.22). We have experienced recurrence of disease after complete resection in 6 cases (4 of 6 patients did not accept radiation therapy). Local recurrence has occurred after an average 15.52 (6−36) months, distant metastasis with an average 19.2 (8–32) months. Overall survival was 11.92 (1–75) months. Six patients are free of tumours at the moment. Conclusions: As overall survival has not increased in recent decades by using combined chemotherapy, there is no congruent consensus associated with the optimal treatment. The standard surgical treatment is total abdominal hysterectomy with bilateral oophorectomy, although due to high rates of recurrence and metastases, the necessity of lymphadenectomy and postoperative treatment is in the focus of recent studies. Though postoperative irradiation improves local control, the beneficial effect on overall survival is still not proven. Adjuvant chemotherapy decreases the rate of both pelvic and extrapelvic recurrence at the same time, although there is no recommendation for the optimal chemoterapeutic agent. Multimodal therapy should lead to better outcomes. Recently there are many ongoing studies with biologic and target therapies to improve efficiency, however, the relevant results will be disclosed in many years only, due to the small number of patients. Orv Hetil. 2018; 159(19): 741–7747.

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